NPI | 1255755716 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208000000X Pediatrics (Licence: CO DR.0075031) |
Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101258686) |
Enumeration Date | 2014-02-04 |
Last Update Date | 2025-07-15 |